Speech mapping in awake high-grade glioma resection: subcortical tract proximity as a predictor of language outcomes.

This study evaluated multimodal resection of language-eloquent HGGs using awake mapping, 5-ALA, and tractography. It highlights the significant risk of transient decline in language function following eloquent tumor resection, particularly if a patient has an existing language deficit. The posterior ILF with its associated reading function appears to be most sensitive to decline and shows the least propensity for functional recovery. Deficits correlated with specific white matter tract involvement, especially when multiple tracts were affected. Proposed stimulation thresholds offer a novel guide for safer resections, supporting a multimodal strategy to balance maximal tumor removal with language preservation.